Comparison of real-time microvascular abnormalities in pediatric and adult sickle cell anemia patients

Authors

  • Anthony T.W. Cheung,

    Corresponding author
    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
    • Department of Pathology and Laboratory Medicine, Research-III Building (Suite 3400), UC Davis Medical Center, 4645 Second Avenue, Sacramento, CA 95817
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  • Joshua W. Miller,

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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  • Sarah M. Craig,

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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  • Patricia L. To,

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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  • Xin Lin,

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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  • Sandra L. Samarron,

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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  • Peter C.Y. Chen,

    1. Shiley Center for Orthopedic Research and Education, Scripps Clinic, La Jolla, California
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  • Theodore Zwerdling,

    1. Department of Pediatrics (Hematology-Oncology), University of California Davis School of Medicine, Sacramento, California
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  • Ted Wun,

    1. Department of Internal Medicine (Hematology-Oncology), University of California Davis School of Medicine, Sacramento, California
    2. Section of Hematology and Oncology, VA Northern California Health Care System, Sacramento, California
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  • Chin-Shang Li,

    1. Department of Public Health Sciences (Biostatistics), University of California Davis School of Medicine, Sacramento, California
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  • Ralph Green

    1. Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
    2. Department of Internal Medicine (Hematology-Oncology), University of California Davis School of Medicine, Sacramento, California
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  • Conflict of interest: Nothing to report.

Abstract

The conjunctival microcirculation in 14 pediatric and eight adult sickle cell anemia (SCA) patients was studied using computer-assisted intravital microscopy. The bulbar conjunctiva in SCA patients in both age groups exhibited a blanched/avascular appearance characterized by decreased vascularity. SCA patients from both age groups had many of the same abnormal morphometric [vessel diameter, vessel distribution, morphometry (shape), tortuosity, arteriole:venule (A:V) ratio, and hemosiderin deposits] and dynamic [vessel sludging/sludged flow, boxcar blood (trickled) flow, and abnormal flow velocity] abnormalities. A severity index (SI) was computed to quantify the degree of vasculopathy for comparison between groups. The severity of vasculopathy differed significantly between the pediatric and adult patients (SI: 4.2 ± 1.8 vs. 6.6 ± 2.4; P = 0.028), indicative of a lesser degree of overall severity in the pediatric patients. Specific abnormalities that were less prominent in the pediatric patients included abnormal vessel morphometry and tortuosity. Sludged flow, abnormal vessel distribution, abnormal A:V ratio, and boxcar flow appeared in high prevalence in both age groups. The results indicate that SCA microvascular abnormalities develop in childhood and the severity of vasculopathy likely progresses with age. Intervention and effective treatment/management modalities should target pediatric patients to ameliorate, slow down, or prevent progressive microvascular deterioration. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc.

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